Spinal correction system and method

ABSTRACT

A spinal correction system comprises a first member configured for attachment to a first portion of vertebral tissue and a second member is configured for attachment to a second portion of the vertebral tissue spaced from the first portion. A third member has a non-flexible configuration relative to the first and second members and is configured for attachment to an apical portion of the vertebral tissue and along at least a portion of at least two vertebrae. The third member extends between a first end connected to the first member at a first transition configured for attachment to the first vertebral tissue and a second end connected to the second member at a second transition configured for attachment to the vertebral tissue. Methods of use are disclosed.

TECHNICAL FIELD

The present disclosure generally relates to medical devices for thetreatment of musculoskeletal disorders, and more particularly to asurgical system and method for correction of a spine disorder.

BACKGROUND

Spinal pathologies and disorders such as scoliosis and other curvatureabnormalities, kyphosis, degenerative disc disease, disc herniation,osteoporosis, spondylolisthesis, stenosis, tumor, and fracture mayresult from factors including trauma, disease and degenerativeconditions caused by injury and aging. Spinal disorders typically resultin symptoms including deformity, pain, nerve damage, and partial orcomplete loss of mobility.

Non-surgical treatments, such as medication, rehabilitation and exercisecan be effective, however, may fail to relieve the symptoms associatedwith these disorders. Surgical treatment of these spinal disordersincludes correction, fusion, fixation, discectomy, laminectomy andimplantable prosthetics. Correction treatments used for positioning andalignment may employ implants, such as vertebral rods, for stabilizationof a treated section of a spine. This disclosure describes animprovement over these prior art technologies.

SUMMARY

Accordingly, a spinal correction construct is provided. The spinalcorrection construct comprises a first member configured for attachmentto a first portion of vertebral tissue. A second member is configuredfor attachment to a second portion of the vertebral tissue spaced fromthe first portion. A third member includes a non-flexible configurationrelative to the first and second members. The third member is configuredfor attachment to an apical portion of the vertebral tissue and along atleast a portion of at least two vertebrae. The third member extendsbetween a first end and a second end. The first end is connected to thefirst member at a first transition and is configured for attachment tothe first vertebral tissue. The second is end connected to the secondmember at a second transition and is configured for attachment to thesecond vertebral tissue.

BRIEF DESCRIPTION OF THE DRAWINGS

The present disclosure will become more readily apparent from thespecific description accompanied by the following drawings, in which:

FIG. 1 is a plan view of components of one embodiment of a spinalcorrection system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 2 is a plan view of vertebrae;

FIG. 3 is a side view of components of the system shown in FIG. 1;

FIG. 4 is a side view of components of the system shown in FIG. 1;

FIG. 5 is a side view of components of the system shown in FIG. 1;

FIG. 6 is a plan view of components of one embodiment of a spinalcorrection system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 7 is a side view of components of the system shown in FIG. 6;

FIG. 8 is a plan view of components of one embodiment of a spinalcorrection system in accordance with the principles of the presentdisclosure disposed with vertebrae;

FIG. 9 is a side view of components of the system shown in FIG. 8;

FIG. 10 is a plan view of components of one embodiment of a spinalcorrection system in accordance with the principles of the presentdisclosure;

FIG. 11 is a plan view of components of one embodiment of a spinalcorrection system in accordance with the principles of the presentdisclosure;

FIG. 12 is a plan view of components of one embodiment of a spinalcorrection system in accordance with the principles of the presentdisclosure; and

FIG. 13 is a plan view of components of one embodiment of a spinalcorrection system in accordance with the principles of the presentdisclosure disposed with vertebrae.

DETAILED DESCRIPTION

The exemplary embodiments of the spinal correction system and relatedmethods of use are discussed in terms of medical devices for thetreatment of musculoskeletal disorders. In some embodiments, the spinalcorrection system may be employed in applications for correction ofdeformities, such as scoliosis, with a device for applying a constantload to a flexible longitudinal element.

In one embodiment, an apical fusion system is provided with adjacentlevel tethering. In one embodiment, the system includes a less-fusiondevice employed with a method for scoliosis correction utilizing thegrowth of a child for continuous correction. In one embodiment, an apexof a curve, for example, including three vertebral levels and/orintervertebral disc space is fused with a spinal rod. In someembodiments, the system tethers adjacent vertebral levels. In oneembodiment, the system includes a transition from a non-deformablelongitudinal member, for example, a metal spinal rod or a PEEK spinalrod for fusion, to a deformable member, for example, a polymer member,an autograft member, an allograft member, and/or a flexible metalmember. The transition is disposed at one vertebral body, on oppositesides, for example, anterior and posterior. In some embodiments, thesystem includes a device employed with a method for scoliosis correctionutilizing part fusion/part fusionless for pediatric patients, and can beused for more aggressive curves.

In one embodiment, an apical fusion system is provided that includes anon-deformable member, a first deformable member, a second deformablemember, a first transition and a second transition. In some embodiments,the non-deformable member provides rigid fixation to vertebrae. In oneembodiment, an apical fusion system provides adjacent level tethering.In one embodiment, the system includes a rod attached to a tether. Inone embodiment, the system includes a rigid rod fixed to a fusionsection of vertebrae and a deformable tether. In one embodiment, the rodis fixed to vertebrae via a bone fastener. In one embodiment, the systemprovides apical fusion at two or more vertebral bodies. In oneembodiment, tethering occurs at two or more vertebral levels.

In one embodiment, the system includes at least two rods connected to atleast one tether. In some embodiments, the rods and tether can beseparately attached, integrally connected or formed as a single piece.In one embodiment, the tether can be contained within at least one plateand/or within at least one rod for permanent fixation of the system withvertebrae. In one embodiment, the at least one tether can be containedwithin at least one rod. In one embodiment, two tethers can be insertedinto two hollow rods. In one embodiment, at least one tether can beattached to a rod. In one embodiment, the rod comprises internalthreading at an end that matingly engages with a tether. In someembodiments, the mating ends of the rod and tether comprise a metal. Inone embodiment, at least one tether is non-permanently fixed to a platevia a set screw.

In one embodiment, the system includes a single rod attached to at leastone tether. In one embodiment, the system includes a double plate andbone fasteners. In some embodiments, the bone fasteners are insertedinto openings in the plate and the rod is set within the head of one ofthe bone fasteners. In some embodiments, a set screw fixes the rod withthe bone fastener. In some embodiments, the tether is set within thehead of one of the bone fasteners and a set screw fixes the tether withthe bone fastener. In one embodiment, the system includes a single plateand a bone fastener.

In one embodiment, an apical fusion system is provided that ispositioned on the lumbar region of the spine. In one embodiment, thesystem is configured to be positioned either anteriorly or posteriorly.In one embodiment, the system is configured for bilateral fusion.

In one embodiment, the system includes a posterior dual rod fusionportion and a posterior tether. In one embodiment, the tether is fixedto a convex side of a vertebral curve. In one embodiment, the systemincludes a posterior dual rod fusion portion and a posterior tetherdisposed along a costo-vertebral space, a transverse process/ribjunction adjacent a costo-vertebral space and/or a costo-transverseligament.

In some embodiments, one or all of the components of the spinalcorrection system may be disposable, peel-pack, pre-packed steriledevices. One or all of the components of the system may be reusable. Thesystem may be configured as a kit with multiple sized and configuredcomponents.

In some embodiments, the present disclosure may be employed to treatspinal disorders such as, for example, degenerative disc disease, discherniation, osteoporosis, spondylolisthesis, stenosis, scoliosis andother curvature abnormalities, kyphosis, tumor and fractures. In someembodiments, the present disclosure may be employed with other ostealand bone related applications, including those associated withdiagnostics and therapeutics. In some embodiments, the disclosed systemmay be alternatively employed in a surgical treatment with a patient ina prone or supine position, and/or employ various surgical approaches tothe spine, including anterior, posterior, posterior mid-line, directlateral, postero-lateral, and/or antero-lateral approaches, and in otherbody regions. The present disclosure may also be alternatively employedwith procedures for treating the lumbar, cervical, thoracic and pelvicregions of a spinal column. The system and methods of the presentdisclosure may also be used on animals, bone models and other non-livingsubstrates, such as, for example, in training, testing anddemonstration.

The present disclosure may be understood more readily by reference tothe following detailed description of the disclosure taken in connectionwith the accompanying drawing figures, which form a part of thisdisclosure. It is to be understood that this disclosure is not limitedto the specific devices, methods, conditions or parameters describedand/or shown herein, and that the terminology used herein is for thepurpose of describing particular embodiments by way of example only andis not intended to be limiting of the claimed disclosure. Also, as usedin the specification and including the appended claims, the singularforms “a,” “an,” and “the” include the plural, and reference to aparticular numerical value includes at least that particular value,unless the context clearly dictates otherwise. Ranges may be expressedherein as from “about” or “approximately” one particular value and/or to“about” or “approximately” another particular value. When such a rangeis expressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about,” it willbe understood that the particular value forms another embodiment. It isalso understood that all spatial references, such as, for example,horizontal, vertical, top, upper, lower, bottom, left and right, are forillustrative purposes only and can be varied within the scope of thedisclosure. For example, the references “upper” and “lower” are relativeand used only in the context to the other, and are not necessarily“superior” and “inferior”.

Further, as used in the specification and including the appended claims,“treating” or “treatment” of a disease or condition refers to performinga procedure that may include administering one or more drugs to apatient (human, normal or otherwise or other mammal), in an effort toalleviate signs or symptoms of the disease or condition. Alleviation canoccur prior to signs or symptoms of the disease or condition appearing,as well as after their appearance. Thus, treating or treatment includespreventing or prevention of disease or undesirable condition (e.g.,preventing the disease from occurring in a patient, who may bepredisposed to the disease but has not yet been diagnosed as having it).In addition, treating or treatment does not require complete alleviationof signs or symptoms, does not require a cure, and specifically includesprocedures that have only a marginal effect on the patient. Treatmentcan include inhibiting the disease, e.g., arresting its development, orrelieving the disease, e.g., causing regression of the disease. Forexample, treatment can include reducing acute or chronic inflammation;alleviating pain and mitigating and inducing re-growth of new ligament,bone and other tissues; as an adjunct in surgery; and/or any repairprocedure. Also, as used in the specification and including the appendedclaims, the term “tissue” includes soft tissue, ligaments, tendons,cartilage and/or bone unless specifically referred to otherwise.

The following discussion includes a description of a spinal correctionsystem in accordance with the principles of the present disclosure.Alternate embodiments are also disclosed. Reference will now be made indetail to the exemplary embodiments of the present disclosure, which areillustrated in the accompanying figures. Turning to FIGS. 1-5, there areillustrated components of a system, such as, for example, a spinalcorrection system 20, in accordance with the principles of the presentdisclosure.

The components of spinal correction system 20 can be fabricated frombiologically acceptable materials suitable for medical applications,including metals, synthetic polymers, ceramics, bone material, tissueand/or their composites, depending on the particular application and/orpreference of a medical practitioner. For example, the components ofspinal correction system 20, individually or collectively, can befabricated from materials such as stainless steel alloys, commerciallypure titanium, titanium alloys, Grade 5 titanium, super-elastic titaniumalloys, cobalt-chrome alloys, stainless steel alloys, superelasticmetallic alloys (e.g., Nitinol, super elasto-plastic metals, such as GUMMETAL® manufactured by Toyota Material Incorporated of Japan), ceramicsand composites thereof such as calcium phosphate (e.g., SKELITE™manufactured by Biologix Inc.), thermoplastics such aspolyaryletherketone (PAEK) including polyetheretherketone (PEEK),polyetherketoneketone (PEKK) and polyetherketone (PEK), carbon-PEEKcomposites, PEEK-BaSO₄ polymeric rubbers, polyethylene terephthalate(PET), fabric, silicone, polyurethane, silicone-polyurethane copolymers,polymeric rubbers, polyolefin rubbers, hydrogels, semi-rigid and rigidmaterials, elastomers, rubbers, thermoplastic elastomers, thermosetelastomers, elastomeric composites, rigid polymers includingpolyphenylene, polyamide, polyimide, polyetherimide, polyethylene,epoxy, bone material including autograft, allograft, xenograft ortransgenic cortical and/or corticocancellous bone, and tissue growth ordifferentiation factors, partially resorbable materials, such as, forexample, composites of metals and calcium-based ceramics, composites ofPEEK and calcium based ceramics, composites of PEEK with resorbablepolymers, totally resorbable materials, such as, for example, calciumbased ceramics such as calcium phosphate, tri-calcium phosphate (TCP),hydroxyapatite (HA)-TCP, calcium sulfate, or other resorbable polymerssuch as polyaetide, polyglycolide, polytyrosine carbonate,polycaroplaetohe and their combinations. Various components of system 20may have material composites, including the above materials, to achievevarious desired characteristics such as strength, rigidity, elasticity,compliance, biomechanical performance, durability and radiolucency orimaging preference. The components of system 20, individually orcollectively, may also be fabricated from a heterogeneous material suchas a combination of two or more of the above-described materials. Thecomponents of system 20 may be monolithically formed, integrallyconnected or include fastening elements and/or instruments, as describedherein.

System 20 is employed, for example, with an open, mini-open or minimallyinvasive surgical technique to attach one or a plurality of longitudinalelements to a first side, such as, for example, a convex side of a spinethat has a spinal disorder. In one embodiment, the longitudinalelement(s), such as, for example, a tether and/or a spinal rod, may beaffixed to the convex side of each of a plurality of vertebrae such thatsystem 20 prevents growth of vertebrae of a selected section of thespine while allowing for growth and adjustments to a second side, suchas, for example, a concave side of the plurality of vertebrae for acorrection treatment to treat various spine pathologies, such as, forexample, adolescent idiopathic scoliosis and Scheuermann's kyphosis.

Spinal correction system 20 includes a member, such as, for example, atether 22 configured for attachment to a first portion of vertebraltissue, such as, for example, a selected section of vertebrae, asdiscussed herein. Tether 22 comprises a flexible longitudinal element,as described herein, which extends between an end 24 and an end 26.Tether 22 defines a longitudinal axis upon disposal in a linearorientation.

In some embodiments, all or only a portion of tether 22 may haveflexible properties, such as the flexible properties corresponding tothe material examples described above, such that tether 22 provides aselective amount of expansion and/or extension in an axial direction. Insome embodiments, all or only a portion of tether 22 may have asemi-rigid, rigid or elastic configuration, and/or have elasticproperties, such as the elastic properties corresponding to the materialexamples described above, such that tether 22 provides a selectiveamount of expansion and/or extension in an axial direction.

In some embodiments, tether 22 has a flexible configuration, whichincludes movement in a lateral or side to side direction and preventsexpanding and/or extension in an axial direction upon fixation withvertebrae. In some embodiments, tether 22 may be compressible in anaxial direction. Tether 22 can include a plurality of separatelyattachable or connectable portions or sections, such as bands or loops,or may be monolithically formed as a single continuous element.

Tether 22 can have a uniform thickness/diameter. In some embodiments,tether 22 may have various surface configurations, such as, for example,rough, threaded for connection with surgical instruments, arcuate,undulating, porous, semi-porous, dimpled, polished and/or texturedaccording to the requirements of a particular application. In someembodiments, the thickness defined by tether 22 may be uniformlyincreasing or decreasing, or have alternate diameter dimensions alongits length. In some embodiments, tether 22 may have various crosssection configurations, such as, for example, oval, oblong, triangular,rectangular, square, polygonal, irregular, uniform, non-uniform,variable and/or tapered.

In some embodiments, tether 22 may have various lengths, according tothe requirements of a particular application. In some embodiments,tether 22 may be braided, such as a rope, or include a pluralityelongated elements to provide a predetermined force resistance. In someembodiments, tether 22 may be made from autograft and/or allograft, asdescribed above, and be configured for resorbable or degradableapplications. In one embodiment, tether 22 is a cadaver tendon. In oneembodiment, tether 22 is a tendon that may be harvested, for example,from a patient or donor. In some embodiments, a tendon harvested from apatient may be affixed in remote locations with the patient's body.

A tether 28, similar to tether 22, extends between an ends 30, 32 and isconfigured for attachment to a first portion of vertebral tissue, suchas, for example, a selected section of vertebrae, as discussed herein.Tether 28 is configured for attachment to a selected section ofvertebrae spaced from the selected section of vertebrae connected totether 22. Tether 28 defines a longitudinal axis upon disposal in alinear orientation. In some embodiments, the selected sections ofvertebrae may be adjacent, staggered and/or offset. In some embodiments,tether 28 can have varying degrees of flexibility relative to tether 22.

A member, such as, for example, a spinal rod 34 extends between ends 36,38 and has a non-flexible configuration relative to each of tethers 22,28. Spinal rod 34 is configured for attachment to an apical portion ofvertebral tissue and along at least a portion of a first vertebra and asecond vertebra, as described herein. Spinal rod 34 is configured fordisposal with vertebrae intermediate tethers 22, 28. In someembodiments, intermediate disposal of spinal rod 34 can includeco-axial, offset, staggered, transverse, angular and/or relativeposterior/anterior orientations with tethers 22, 28. Spinal rod 34defines a longitudinal axis upon disposal in a linear orientation.

In some embodiments, spinal rod 34 has a rigid and/or non-flexibleconfiguration relative to tether 22 and/or tether 28 such that all oronly a portion of spinal rod 34 may have a semi-rigid, rigid or elasticconfiguration, and/or have elastic properties, such as the elasticproperties corresponding to the material examples described above. Insome embodiments, spinal rod 34 provides a selective amount of expansionand/or extension in an axial direction. In some embodiments, spinal rod34 has a flexible configuration, which includes movement in a lateral orside to side direction and prevents expanding and/or extension in anaxial direction upon fixation with vertebrae. In some embodiments,spinal rod 34 may be compressible in an axial direction. Spinal rod 34can include a plurality of separately attachable or connectable portionsor sections, or may be monolithically formed as a single continuouselement. System 20 can include one or a plurality of spinal rods 34. Insome embodiments, spinal rod 34 is configured to extend over a pluralityof vertebral levels.

Spinal rod 34 can have a uniform thickness/diameter. In someembodiments, spinal rod 34 may have various surface configurations, suchas, for example, rough, threaded for connection with surgicalinstruments, arcuate, undulating, porous, semi-porous, dimpled, polishedand/or textured according to the requirements of a particularapplication. In some embodiments, the thickness defined by spinal rod 34may be uniformly increasing or decreasing, or have alternate diameterdimensions along its length. In some embodiments, spinal rod 34 may havevarious cross section configurations, such as, for example, oval,oblong, triangular, rectangular, square, polygonal, irregular, uniform,non-uniform, variable and/or tapered.

A transition, such as, for example, a plate 40 includes bone fasteners42, 44 configured for fixation with vertebrae. Plate 40 has asubstantially rectangular configuration. In some embodiments, plate 40can be variously configured, such as, for example, tubular, oval,oblong, triangular, square, polygonal, irregular, uniform, non-uniform,variable, hollow and/or tapered. In some embodiments, plate 40 can havealternate cross-section and/or thickness configurations, such as,arcuate, undulating, offset, staggered, tubular, oval, oblong,triangular, square, polygonal, irregular, uniform, variable, hollowand/or tapered. In some embodiments, plate 40 may include alternatesurface configurations, such as, for example, friction, rough, arcuate,undulating, mesh, porous, semi-porous, dimpled and/or textured accordingto the requirements of a particular application.

Plate 40 has a double plate configuration and includes an opening 46configured for disposal of bone fastener 42 and an opening 48 configuredfor disposal of bone fastener 44. Opening 46 is spaced from opening 48along the surface of plate 40 for alignment with tether 22, tether 28and/or spinal rod 34, according to the requirements of a particularapplication. Openings 46, 48 are substantially circular and extendthrough the thickness of plate 40. In some embodiments, opening 46and/or opening 48 can be variously configured, such as, for example,oval, oblong, triangular, square, polygonal, irregular, uniform,non-uniform and/or tapered.

Opening 46 is configured to receive bone fastener 42 that connectstether 22 to plate 40 and/or tissue, as will be described. Bone fastener42 has a length that is extendable along a longitudinal axis. Bonefastener 42 comprises a head 50 and an elongated shaft 52 configured forpenetrating tissue, as shown in FIG. 3.

Shaft 52 has a cylindrical cross section configuration and includes anouter surface having an external thread form. In some embodiments, theexternal thread form may include a single thread turn or a plurality ofdiscrete threads. In some embodiments, other engaging structures may belocated on shaft 52, such as, for example, a nail configuration, barbs,expanding elements, raised elements and/or spikes to facilitateengagement of shaft 52 with tissue, such as, for example, vertebrae.

In some embodiments, all or only a portion of the shaft 52 may havealternate cross section configurations, such as, for example, oval,oblong, triangular, square, polygonal, irregular, uniform, non-uniform,offset, staggered, undulating, arcuate, variable and/or tapered. In someembodiments, the outer surface of shaft 52 may include one or aplurality of openings. In some embodiments, all or only a portion of theouter surface of shaft 52 may have alternate surface configurations toenhance fixation with tissue such as, for example, rough, arcuate,undulating, mesh, porous, semi-porous, dimpled and/or textured accordingto the requirements of a particular application. In some embodiments,all or only a portion of shaft 52 may be disposed at alternateorientations, relative to the longitudinal axis, such as, for example,transverse, perpendicular and/or other angular orientations such asacute or obtuse, co-axial and/or may be offset or staggered. In someembodiments, that all or only a portion of shaft 52 may be cannulated.

Head 50 includes a pair of spaced apart arms having an inner surfacethat defines a U-shaped passageway 54. Passageway 54 is configured fordisposal of an implant, such as, for example, tether 22. In someembodiments, all or only a portion of passageway 54 may have alternatecross section configurations, such as, for example, oval, oblong,triangular, square, polygonal, irregular, uniform, non-uniform, offset,staggered, and/or tapered. In some embodiments, the arms of head 50 maybe disposed at alternate orientations, relative to the longitudinalaxis, such as, for example, transverse, perpendicular and/or otherangular orientations such as acute or obtuse, co-axial and/or may beoffset or staggered.

The inner surface of head 50 includes a thread form configured forengagement with a coupling member, such as, for example, a set screw 56.Screw 56 is threadably engageable with the inner surface of head 50 toconnect, attach, fix and/or lock, provisionally, removably and/orpermanently, tether 22 to plate 40 and/or tissue, as will be described.Screw 56 includes an element 58 that penetrates tether 22 to facilitateconnection of the components of system 20 and tissue.

Opening 48 is configured to receive bone fastener 44 that connectsspinal rod 34 to plate 40 and/or tissue, as will be described. Bonefastener 44 has a length that is extendable along a longitudinal axis.Bone fastener 44, similar to bone fastener 42, comprises a head 60 andan elongated shaft 62 configured for penetrating tissue, as shown inFIG. 3. The inner surface of head 60 includes a thread form configuredfor engagement with a coupling member, such as, for example, a set screw64. Set screw 64 is threaded with head 60 to connect, attach, fix and/orlock, provisionally, removably and/or permanently, spinal rod 34 toplate 40 and/or tissue, as will be described.

A transition, such as, for example, a plate 66, similar to plate 40,includes bone fasteners 68, 70 configured for fixation with vertebrae.Plate 66 has a double plate configuration and includes an opening 72configured for disposal of bone fastener 68 and an opening 74 configuredfor disposal of bone fastener 70. Opening 72 is spaced from opening 74along the surface of plate 66 for alignment with tether 22, tether 28and/or spinal rod 34, according to the requirements of a particularapplication.

Opening 72 is configured to receive bone fastener 68 that connectstether 28 to plate 66 and/or tissue, as will be described. Bone fastener68 has a length that is extendable along a longitudinal axis. Bonefastener 68, similar to bone fastener 42, comprises a head 76 and anelongated shaft (not shown) configured for penetrating tissue.

Head 76 includes a pair of spaced apart arms having an inner surfacethat defines a U-shaped passageway configured for disposal of animplant, such as, for example, tether 28. The inner surface of head 76includes a thread form configured for engagement with a coupling member,such as, for example, a set screw 78, similar to screw 56. Screw 78 isthreadably engageable with the inner surface of head 76 to connect,attach, fix and/or lock, provisionally, removably and/or permanently,tether 28 to plate 66 and/or tissue, as will be described.

Opening 74 is configured to receive bone fastener 70 that connectsspinal rod 34 to plate 66 and/or tissue, as will be described. Bonefastener 70 has a length that is extendable along a longitudinal axis.Bone fastener 70, similar to bone fastener 44, comprises a head 80 andan elongated shaft (not shown) configured for penetrating tissue. Theinner surface of head 80 includes a thread form configured forengagement with a coupling member, such as, for example, a set screw 82,similar to set screw 64. Set screw 82 is threaded with head 80 toconnect, attach, fix and/or lock, provisionally, removably and/orpermanently, spinal rod 34 to plate 66 and/or tissue, as will bedescribed.

A plate 84, as shown in FIG. 4, has a single plate configuration andincludes an opening 86 configured for disposal of bone fastener 42,described herein, to connect, attach, fix and/or lock, provisionally,removably and/or permanently, tether 22 to tissue, as will be described.A plate 88, as shown in FIG. 5, has a single plate configuration andincludes an opening 90 configured for disposal of bone fastener 44,described herein, to connect, attach, fix and/or lock, provisionally,removably and/or permanently, spinal rod 34 to tissue, as will bedescribed. A plate 92 has a single plate configuration and includes anopening 94 configured for disposal of bone fastener 68, describedherein, to connect, attach, fix and/or lock, provisionally, removablyand/or permanently, tether 28 to tissue, as will be described.

In some embodiments, spinal correction system 20 can include one or aplurality of fasteners, such as those described herein and/or fixationelements, which may be employed with a single vertebral level or aplurality of vertebral levels. In some embodiments, the fasteners may beengaged with vertebrae in various orientations, such as, for example,series, parallel, offset, staggered and/or alternate vertebral levels.In some embodiments, the fasteners and/or fixation elements may includeone or a plurality of multi-axial screws, sagittal angulation screws,pedicle screws, mono-axial screws, uni-planar screws, fixed screws,tissue penetrating screws, conventional screws, expanding screws,wedges, anchors, buttons, clips, snaps, friction fittings, compressivefittings, expanding rivets, staples, nails, adhesives, posts, fixationplates and/or posts. These bone fasteners and/or fixation elements maybe coated with an osteoinductive or osteoconductive material to enhancefixation, and/or include one or a plurality of therapeutic agents.

In assembly, operation and use, spinal correction system 20, similar tothe system described above, is employed with a surgical procedure, suchas, for a correction treatment to treat adolescent idiopathic scoliosisand/or Scheuermann's kyphosis of a spine. In some embodiments, one orall of the components of spinal correction system 20 can be delivered orimplanted as a pre-assembled device or can be assembled in situ. Spinalcorrection system 20 may be completely or partially revised, removed orreplaced.

For example, as shown in FIGS. 1 and 2, spinal correction system 20 canbe employed with a surgical correction treatment of an applicablecondition or injury of an affected section of a spinal column andadjacent areas within a body, such as, for example, vertebrae V1-V9 ofvertebrae V. In some embodiments, spinal correction system 20 may beemployed with one or a plurality of vertebrae.

In use, to treat a selected section of vertebrae V, which includes anapical portion A of vertebrae V, a medical practitioner obtains accessto a surgical site including vertebrae V in any appropriate manner, suchas through incision and retraction of tissues. In some embodiments,spinal correction system 20 can be used in any existing surgical methodor technique including open surgery, mini-open surgery, minimallyinvasive surgery and percutaneous surgical implantation, wherebyvertebrae V is accessed through a mini-incision, or sleeve that providesa protected passageway to the area. Once access to the surgical site isobtained, the particular surgical procedure can be performed fortreating the spine disorder.

An incision is made in the body of a patient and a cutting instrument(not shown) creates a surgical pathway for implantation of components ofspinal correction system 20. A preparation instrument (not shown) can beemployed to prepare tissue surfaces of vertebrae V, as well as foraspiration and irrigation of a surgical region according to therequirements of a particular surgical application.

Pilot holes are made in vertebrae V for receiving bone fasteners 42, 44,68, 70 that connect plates 40, 66, 84, 88, 92, tethers 22, 28 and spinalrod 34 with vertebrae V1-V9. In some embodiments, the sequence and/ororder of connecting bone fasteners 42, 44, 68, 70, plates 40, 66, 84,88, 92, tethers 22, 28 and spinal rod 34 with vertebrae V1-V9, may bevariously arranged.

For example, a pilot hole is made in vertebra V3 for receiving bonefastener 42 that connects tether 22 and plate 84 with vertebra V3. Plate84 is removably engaged with a delivery instrument (not shown) anddelivered along the surgical pathway. Plate 84 is delivered to asurgical site adjacent vertebra V3. Plate 84 is oriented for fixationwith vertebra V3. Bone fastener 42 is inserted or otherwise engaged withvertebra V3 to fix an intermediate portion of tether 22 with plate 84and vertebra V3. Bone fasteners 42 are similarly inserted or otherwiseengaged with vertebrae V1, V2 to fix tether 22 with plates 84 andvertebrae V1, V2.

A pilot hole is made in vertebra V4 for receiving bone fastener 42. Thepilot hole in vertebra V4 is disposed to connect tether 22 in a selectedalignment with bone fastener 42 attached to vertebra V3 along vertebraeV. Bone fastener 42 connects end 26 of tether 22 and plate 40 withvertebra V4. A pilot hole is made in vertebra V4 for receiving bonefastener 44 and is spaced laterally from the pilot hole for bonefastener 42 in vertebra V4. Bone fastener 44 connects end 36 of spinalrod 34 and plate 40 with vertebra V4. Plate 40 is removably engaged witha delivery instrument (not shown) and delivered along the surgicalpathway. Plate 40 is delivered to a surgical site adjacent vertebra V4.Plate 40 is oriented for fixation with vertebra V4. Bone fastener 42 isinserted or otherwise engaged with vertebra V4 to fix end 26 with plate40 and vertebra V4. Bone fastener 44 is inserted or otherwise engagedwith vertebra V4 to fix end 36 with plate 40 and vertebra V4.

A pilot hole is made in vertebra V5 for receiving bone fastener 44. Thepilot hole in vertebra V5 is disposed to connect spinal rod 34 in aselected alignment with bone fastener 44 attached to vertebra V4 and/orvertebra V6 along vertebrae V. Bone fastener 44 connects an intermediateportion of spinal rod 34 and plate 88 with vertebra V5. Plate 88 isremovably engaged with a delivery instrument (not shown) and deliveredalong the surgical pathway. Plate 88 is delivered to a surgical siteadjacent vertebra V5. Plate 88 is oriented for fixation with vertebraV5. Bone fastener 44 is inserted or otherwise engaged with vertebra V5to fix an intermediate portion of spinal rod 34 with plate 88 andvertebra V5.

A pilot hole is made in vertebra V6 for receiving bone fastener 70. Thepilot hole in vertebra V6 is disposed to connect spinal rod 34 in aselected alignment with bone fastener 44 attached to vertebra V5 alongvertebrae V. Bone fastener 70 connects end 38 of spinal rod 34 and plate66 with vertebra V6. A pilot hole is made in vertebra V6 for receivingbone fastener 68 and is spaced laterally from the pilot hole for bonefastener 70 in vertebra V6. Bone fastener 68 connects end 30 of tether28 and plate 66 with vertebra V6. Plate 66 is removably engaged with adelivery instrument (not shown) and delivered along the surgicalpathway. Plate 66 is delivered to a surgical site adjacent vertebra V6.Plate 66 is oriented for fixation with vertebra V6. Bone fastener 70 isinserted or otherwise engaged with vertebra V6 to fix end 38 with plate66 and vertebra V6. Bone fastener 68 is inserted or otherwise engagedwith vertebra V6 to fix end 30 with plate 66 and vertebra V6.

A pilot hole is made in vertebra V7 for receiving bone fastener 68. Thepilot hole in vertebra V7 is disposed to connect tether 28 in a selectedalignment with bone fastener 68 attached to vertebra V6 along vertebraeV. Bone fastener 68 connects an intermediate portion of tether 28 andplate 92 with vertebra V7. Plate 92 is removably engaged with a deliveryinstrument (not shown) and delivered along the surgical pathway. Plate92 is delivered to a surgical site adjacent vertebra V7. Plate 92 isoriented for fixation with vertebra V7. Bone fastener 68 is inserted orotherwise engaged with vertebra V7 to fix an intermediate portion oftether 28 with plate 92 and vertebra V7. Bone fasteners 68 are similarlyinserted or otherwise engaged with vertebrae V8, V9 to fix tether 28with plates 92 and vertebrae V8, V9.

As shown in FIGS. 1 and 2, spinal rod 34 is attached with apical portionA, and tether 22 and tether 28 are axially spaced along vertebrae V.Tether 22 and tether 28 are disposed in a substantially co-axialarrangement along vertebrae V. Spinal rod 34 and tethers 22, 28 aredisposed in a substantially offset and/or staggered arrangement alongvertebrae V. In this configuration, the components of spinal correctionsystem 20 are attached with a first side, such as, for example, a convexside of vertebrae V to prevent growth of a selected section of vertebraeV, while allowing for growth and adjustments to a second side, such as,for example, a concave side of vertebrae V to provide treatment.Compression of vertebrae V occurs along the convex side. As forcesand/or force changes are applied to spinal correction system 20, suchas, for example, patient growth, trauma and degeneration, and/or system20 component creep, deformation, damage and degeneration, tether 22and/or tether 28 adapts with a responsive force to maintain the appliedforce transmitted from the bone fasteners substantially constant.

In one embodiment, spinal correction system 20 includes an agent, whichmay be disposed, packed or layered within, on or about the componentsand/or surfaces of spinal correction system 20. For example, the platescan comprise one or a plurality of surface treatments and/or coatingsincluding the agent. In some embodiments, the agent may include bonegrowth promoting material, such as, for example, bone graft to enhancefixation of the fixation elements with vertebrae V.

In some embodiments, the agent may include therapeutic polynucleotidesor polypeptides. In some embodiments, the agent may includebiocompatible materials, such as, for example, biocompatible metalsand/or rigid polymers, such as, titanium elements, metal powders oftitanium or titanium compositions, sterile bone materials, such asallograft or xenograft materials, synthetic bone materials such as coraland calcium compositions, such as HA, calcium phosphate and calciumsulfite, biologically active agents, for example, gradual releasecompositions such as by blending in a bioresorbable polymer thatreleases the biologically active agent or agents in an appropriate timedependent fashion as the polymer degrades within the patient. Suitablebiologically active agents include, for example, BMP, Growth andDifferentiation Factors proteins (GDF) and cytokines. The components ofspinal correction system 20 can be made of radiolucent materials such aspolymers. Radiomarkers may be included for identification under x-ray,fluoroscopy, CT or other imaging techniques. In some embodiments, theagent may include one or a plurality of therapeutic agents and/orpharmacological agents for release, including sustained release, totreat, for example, pain, inflammation and degeneration.

In some embodiments, the use of microsurgical and image guidedtechnologies may be employed to access, view and repair spinaldeterioration or damage, with the aid of spinal correction system 20.Upon completion of the procedure, the surgical instruments, assembliesand non-implant components of spinal correction system 20 are removedfrom the surgical site and the incision is closed.

In some embodiments, the components of spinal correction system 20 maybe employed to treat progressive idiopathic scoliosis with or withoutsagittal deformity in either infantile or juvenile patients, includingbut not limited to prepubescent children, adolescents from 10-12 yearsold with continued growth potential, and/or older children whose growthspurt is late or who otherwise retain growth potential. In someembodiments, the components of spinal correction system 20 and method ofuse may be used to prevent or minimize curve progression in individualsof various ages.

In one embodiment, as shown in FIGS. 6 and 7, spinal correction system20, similar to the systems and methods described herein, is employedwith a surgical correction treatment of an applicable condition orinjury of an affected section of a spinal column and adjacent areaswithin a body, such as, for example, vertebrae V1-V9 of vertebrae V.

Spinal correction system 20 comprises a spinal rod 124, similar tospinal rod 34 described herein, extending between ends 126, 128 and aplate 102, similar to the plates 40, 66 described above, having a doubleplate configuration and including an opening 104 configured for disposalof bone fastener 44, described herein, and an opening 106 configured fordisposal of bone fastener 44. Opening 106 is spaced from opening 104along the surface of plate 102 for alignment of spinal rods 34, 124described. Plate 102 includes a cavity 108 configured for disposal oftether 22, described herein. The inner surface of cavity 108 includes athread form configured for engagement with set screw 56, describedherein. Screw 56 is threadably engageable with the inner surface ofcavity 108 to connect, attach, fix and/or lock, provisionally, removablyand/or permanently, tether 22 with plate 102 to facilitate connection ofthe components of system 20 and tissue.

A plate 110, similar to the plates 40, 66 described above, has a doubleplate configuration and includes an opening 112 configured for disposalof bone fastener 44 and an opening 114 configured for disposal of bonefastener 44. Opening 114 is spaced from opening 112 along the surface ofplate 110 for alignment spinal rods 34, 124.

A plate 116, similar to the plate 102 described above, has a doubleplate configuration and includes an opening 118 configured for disposalof bone fastener 44 and an opening 120 configured for disposal of bonefastener 44. Opening 120 is spaced from opening 118 along the surface ofplate 116 for alignment of spinal rods 34, 124. Plate 116 includes acavity 122 configured for disposal of tether 28. The inner surface ofcavity 122 includes a thread form configured for engagement with setscrew 56 to connect, attach, fix and/or lock, provisionally, removablyand/or permanently, tether 28 with plate 116 to facilitate connection ofthe components of system 20 and tissue.

In use, similar to the methods described herein, pilot holes are made invertebrae V for receiving bone fasteners 42, 44 that connect plates 84,102, 110, 116, 92, tethers 22, 28 and spinal rod 34, 124 with vertebraeV1-V9. In some embodiments, the sequence and/or order of connecting bonefasteners 42, 44 plates 84, 102, 110, 116, 92, tethers 22, 28 and spinalrod 34, 124 with vertebrae V1-V9, may be variously arranged.

A pilot hole is made in vertebra V3 for receiving bone fastener 42 thatconnects tether 22 and plate 84 with vertebra V3. Plate 84 is removablyengaged with a delivery instrument (not shown) and delivered along thesurgical pathway. Plate 84 is delivered to a surgical site adjacentvertebra V3. Plate 84 is oriented for fixation with vertebra V3. Bonefastener 42 is inserted or otherwise engaged with vertebra V3 to fix anintermediate portion of tether 22 with plate 84 and vertebra V3. Bonefasteners 42 are similarly inserted or otherwise engaged with vertebraeV1, V2 to fix tether 22 with plate 84 and vertebrae V1, V2.

Pilot holes are made in vertebra V4 for receiving bone fasteners 44. Thepilot holes in vertebra V4 are disposed to connect rods 34, 124 in anoffset alignment with bone fastener 42 attached to vertebra V3 alongvertebrae V. Pilot holes are made in vertebra V4 for receiving bonefasteners 44. Bone fasteners 44 connect end 36 of rod 34 and end 126 ofrod 124 and plate 102 with vertebra V4. Plate 102 is removably engagedwith a delivery instrument (not shown) and delivered along the surgicalpathway. Plate 102 is delivered to a surgical site adjacent vertebra V4.Plate 102 is oriented for fixation with vertebra V4. Bone fasteners 44are inserted or otherwise engaged with vertebra V4 to fix end 26 and end126 with plate 102 and vertebra V4. End 26 of tether 22 is fixed withplate 102 and connected to vertebra V4.

Pilot holes are made in vertebra V5 for receiving bone fasteners 44. Thepilot holes in vertebra V5 are disposed to connect spinal rods 34, 124in a selected alignment with bone fasteners 44 attached to vertebra V4and/or vertebra V6 along vertebrae V. Bone fastener 44 connects anintermediate portion of spinal rods 34, 124 and plate 110 with vertebraV5. Plate 110 is removably engaged with a delivery instrument (notshown) and delivered along the surgical pathway. Plate 110 is deliveredto a surgical site adjacent vertebra V5. Plate 110 is oriented forfixation with vertebra V5. Bone fasteners 44 are inserted or otherwiseengaged with vertebra V5 to fix an intermediate portion of spinal rods34, 124 with plate 110 and vertebra V5.

Pilot holes are made in vertebra V6 for receiving bone fasteners 44being spaced laterally apart from each other along vertebrae V6. Thepilot holes in vertebra V6 are disposed to connect rods 34, 124 inalignment with bone fasteners 44 attached to vertebra V5 along vertebraeV. Bone fasteners 44 connect end 38 of spinal rod 34, end 128 of spinalrod 124 and plate 116 with vertebra V6. Plate 116 is removably engagedwith a delivery instrument (not shown) and delivered along the surgicalpathway. Plate 116 is delivered to a surgical site adjacent vertebra V6.Plate 116 is oriented for fixation with vertebra V6. Bone fasteners 44are inserted or otherwise engaged with vertebra V6 to fix ends 38, 128with plate 116 and vertebra V6. End 30 of tether 28 is fixed with plate116 and vertebra V6.

A pilot hole is made in vertebra V7 for receiving bone fastener 68. Thepilot hole in vertebra V7 is disposed to connect tether 28 in an offsetalignment with bone fasteners 44 attached to vertebra V6 along vertebraeV. Bone fastener 68 connects an intermediate portion of tether 28 andplate 92 with vertebra V7. Plate 92 is removably engaged with a deliveryinstrument (not shown) and delivered along the surgical pathway. Plate92 is delivered to a surgical site adjacent vertebra V7. Plate 92 isoriented for fixation with vertebra V7. Bone fastener 68 is inserted orotherwise engaged with vertebra V7 to fix an intermediate portion oftether 28 with plate 92 and vertebra V7. Bone fasteners 68 are similarlyinserted or otherwise engaged with vertebrae V8, V9 to fix tether 28with plates 92 and vertebrae V8, V9.

As shown in FIG. 6, spinal rods 34, 124 are attached with an apicalportion of vertebrae V, and tether 22 and tether 28 are axially spacedalong vertebrae V. Tether 22 and tether 28 are disposed in an offsetarrangement with respect to rods 34, 124 along vertebrae V. Spinal rods34, 124 are disposed in a substantially parallel arrangement along theapical portion of vertebrae V.

In one embodiment, as shown in FIGS. 8 and 9, spinal correction system20, similar to the systems and methods described herein, includes aspinal rod 234, similar to the spinal rods described herein, and tethers222, 228, similar to the tethers described herein.

Spinal rod 234 extends between ends 236, 238. End 236 includes a cavity240 having an inner surface. The inner surface of cavity 240 includes athread form configured for engagement and connection with an end oftether 222. End 238 includes a cavity (not shown), similar to end 236above, having an inner surface. The inner surface of the cavity at end238 includes a thread form configured for engagement and connection withan end of tether 228, discussed below.

Tether 222 includes a flange 242 extending from end 226. Flange 242 isthreadably engageable with cavity 240 such that rod 234 and tether 222are in axial alignment. Tether 228 includes a flange (not shown),similar to flange 242 described above, extending from end 230. Theflange at end 230 is threadably engageable with the cavity of at end 238of rod 234 such that rod 234 and tether 222 are in axial alignment. Insome embodiments, the flange of tether 222 and/or tether 228 can be arigid component, for example, those materials described herein, relativeto the tether. System 20 includes plates 244, 246, similar to plate 88discussed above. Tethers 222, 228 and spinal rod 234 can be fixed and/orlocked, provisionally, removably and/or permanently. In someembodiments, end 236 and/or end 238 can include a flange, as describedabove, and end 226 and/or end 230 can include a surface defining acavity, as described above, for threaded engagement with the flange andconnection of rod 234 and tethers 222, 228.

In some embodiments, system 20 can alternatively connect and/or join therelatively rigid and non-rigid components of system 20, for example, toco-axially align spinal rod 234 and tethers 222, 228. For example, inone embodiment, as shown in FIG. 10, end 236 includes a cavity, such as,for example, a keyway 436 having an inner surface configured as a femalemating part. The inner surface of keyway 436 is configured forengagement and connection with an end of tether 222. Tether 222 includesa key 424 configured as a male mating part extending from end 226. Key424 is manipulated for lateral assembly with keyway 436 such that rod234 and tether 222 are in co-axial alignment. The surface of key 424 andthe surface that defines keyway 436 engage to prevent axialdisengagement of tether 222 and rod 234. In some embodiments, end 236can include a key, as described above, and end 226 can include a surfacedefining a keyway, as described above, for engagement with the key andconnection of rod 234 and tether 222.

In one embodiment, as shown in FIG. 11, end 236 includes a hook 536having an arcuate configuration and end 226 includes a suture loop 524to connect and/or join the relatively rigid and non-rigid components ofsystem 20, for example, to co-axially align spinal rod 234 and tethers222, 228. Loop 524 is configured to wrap around hook 536 such that loop524 is removably connected with hook 536. In one embodiment, as shown inFIG. 12, end 236 includes a plurality of spaced apart through openings636 and end 226 includes a suture loop 624 to connect and/or join therelatively rigid and non-rigid components of system 20, for example, toco-axially align spinal rod 234 and tethers 222, 228. Loop 624 isselectively disposed with one of openings 636 such that loop 524 isfixedly and/or permanently connected with end 236. In some embodiments,openings 636 are spaced at increments along end 236. In someembodiments, the incremental spacing allows for adjustment of the lengthof the tethers and/or rods. In some embodiments, end 236 can be cut to adesired length.

Pilot holes are made in vertebrae V for receiving bone fasteners 42, 44that connect plates 84, 88, 244, 246, 92, tethers 222, 228 and spinalrod 234 with vertebrae V1-V9. In some embodiments, the sequence and/ororder of connecting bone fasteners 42, 44, plates 84, 88, 244, 246, 92,tethers 222, 228 and spinal rod 234 with vertebrae V1-V9, may bevariously arranged.

A pilot hole is made in vertebra V3 for receiving bone fastener 42 thatconnects tether 222 and plate 84 with vertebra V3. Plate 84 is removablyengaged with a delivery instrument (not shown) and delivered along thesurgical pathway. Plate 84 is delivered to a surgical site adjacentvertebra V3. Plate 84 is oriented for fixation with vertebra V3. Bonefastener 42 is inserted or otherwise engaged with vertebra V3 to fix anintermediate portion of tether 222 with plate 84 and vertebra V3. Bonefasteners 42 are similarly inserted or otherwise engaged with vertebraeV1, V2 to fix tether 222 with plate 84 and vertebrae V1, V2.

A pilot hole is made in vertebra V4 for receiving bone fastener 44.Tether 224 is fixed with spinal rod 234. Bone fastener 44 connects end236 of rod 234 and plate 88 with vertebra V4. A pilot hole is made invertebra V4 for receiving bone fastener 44 placed in axial alignmentwith bone fastener 42 of vertebrae V3. Bone fastener 44 connects end 236of spinal rod 234 and plate 88 with vertebra V4. Plate 88 is removablyengaged with a delivery instrument (not shown) and delivered along thesurgical pathway. Plate 88 is delivered to a surgical site adjacentvertebra V4. Plate 88 is oriented for fixation with vertebra V4. Bonefastener 44 is inserted or otherwise engaged with vertebra V4 to fix end236 with plate 88 and vertebra V4.

A pilot hole is made in vertebra V5 for receiving bone fastener 44. Thepilot hole in vertebra V5 is disposed to connect spinal rod 234 in aselected alignment with bone fastener 44 attached to vertebra V4 and/orvertebra V6 along vertebrae V. Bone fastener 44 connects an intermediateportion of spinal rod 234 and plate 244 with vertebra V5. Plate 244 isremovably engaged with a delivery instrument (not shown) and deliveredalong the surgical pathway. Plate 244 is delivered to a surgical siteadjacent vertebra V5. Plate 244 is oriented for fixation with vertebraV5. Bone fastener 44 is inserted or otherwise engaged with vertebra V5to fix an intermediate portion of spinal rod 234 with plate 244 andvertebra V5.

A pilot hole is made in vertebra V6 for receiving bone fastener 44. Thepilot hole in vertebra V6 is disposed to connect spinal rod 234 in aselected alignment with bone fastener 44 attached to vertebra V5 alongvertebrae V. The flange disposed on end 230 of tether 228 is engagedwith end 238 of spinal rod 234. Bone fastener 44 connects end 238 ofspinal rod 234 and plate 246 with vertebra V6. A pilot hole is made invertebra V6 for receiving bone fastener 44 and is spaced in axialalignment with fastener 44 in vertebrae V5. Plate 246 is removablyengaged with a delivery instrument (not shown) and delivered along thesurgical pathway. Plate 246 is delivered to a surgical site adjacentvertebra V6. Plate 246 is oriented for fixation with vertebra V6. Bonefastener 44 is inserted or otherwise engaged with vertebra V6 to fix end238 with plate 246 and vertebra V6.

A pilot hole is made in vertebra V7 for receiving bone fastener 42. Thepilot hole in vertebra V7 is disposed to connect tether 228 in aselected alignment with bone fastener 44 attached to vertebra V6 alongvertebrae V. Bone fastener 42 connects an intermediate portion of tether228 and plate 92 with vertebra V7. Plate 92 is removably engaged with adelivery instrument (not shown) and delivered along the surgicalpathway. Plate 92 is delivered to a surgical site adjacent vertebra V7.Plate 92 is oriented for fixation with vertebra V7. Bone fastener 68 isinserted or otherwise engaged with vertebra V7 to fix an intermediateportion of tether 28 with plate 92 and vertebra V7. Bone fasteners 42are similarly inserted or otherwise engaged with vertebrae V8, V9 to fixtether 28 with plates 92 and vertebrae V8, V9.

As shown in FIG. 8, spinal rod 234 is attached with an apical portion ofvertebrae V, and tether 222 and tether 228 are axially spaced alongvertebrae V. Spinal rod 234 and tethers 222, 228 are disposed in asubstantially coaxial arrangement along vertebrae V.

In one embodiment, as shown in FIG. 13, spinal correction system 20,similar to the systems and methods described herein, is employed with alumbar section of vertebrae V. Spinal correction system 20 includes aplate 302, similar to the plate 66 described above. Plate 302 has adouble plate configuration and includes an opening 304 configured fordisposal of bone fastener 44 and an opening 306 configured for disposalof bone fastener 44. Opening 306 is spaced from opening 304 along thesurface of plate 302 for alignment of spinal rods 234, 124, describedabove.

A plate 308, similar to the plate 302 described above, has a doubleplate configuration and includes an opening 310 configured for disposalof bone fastener 44 and an opening 312 configured for disposal of bonefastener 44. Opening 312 is spaced from opening 310 along the surface ofplate 308 for alignment spinal rods 234, 124.

A plate 314, similar to the plate 302 described above, has a doubleplate configuration and includes an opening 316 configured for disposalof bone fastener 44 and an opening 318 configured for disposal of bonefastener 44. Opening 318 is spaced from opening 316 along the surface ofplate 314 for alignment spinal rods 234, 124.

Pilot holes are made in vertebrae V for receiving bone fasteners 42, 44,68 that connect plates 84, 302, 308, 314, 92, tethers 222, 228 andspinal rods 234, 124 with vertebrae V1-V9. In some embodiments, thesequence and/or order of connecting bone fasteners 42, 44, 68, plates84, 302, 308, 314, 92, tethers 222, 228 and spinal rods 234, 124 withvertebrae V1-V9, may be variously arranged.

A pilot hole is made in vertebra V3 for receiving bone fastener 42 thatconnects tether 222 and plate 84 with vertebra V3. Plate 84 is removablyengaged with a delivery instrument (not shown) and delivered along thesurgical pathway. Plate 84 is delivered to a surgical site adjacentvertebra V3. Plate 84 is oriented for fixation with vertebra V3. Bonefastener 42 is inserted or otherwise engaged with vertebra V3 to fix anintermediate portion of tether 222 with plate 84 and vertebra V3. Bonefasteners 42 are similarly inserted or otherwise engaged with vertebraeV1, V2 to fix tether 222 with plate 84 and vertebrae V1, V2.

Pilot holes are made in vertebra V4 for receiving bone fasteners 44.Pilot holes in vertebra V4 are disposed to connect rods 234, 124 tovertebra V4 along vertebrae V to plate 302. Pilot holes are made invertebra V4 for receiving bone fasteners 44 being spaced laterally fromeach other in vertebra V4. End 226 of tether 222 is threadably engagedwith end 236 of spinal rod 234 in axial alignment. Bone fasteners 44connect end 236 of rod 234 and end 126 of rod 124 and plate 302 withvertebra V4. Rod 124 is positioned offset from rod 234 and tether 222.Plate 302 is removably engaged with a delivery instrument (not shown)and delivered along the surgical pathway. Plate 302 is delivered to asurgical site adjacent vertebra V4. Plate 302 is oriented for fixationwith vertebra V4. Bone fasteners 44 are inserted or otherwise engagedwith vertebra V4 to fix end 236 and end 126 with plate 302 and vertebraV4.

Pilot holes are made in vertebra V5 for receiving bone fasteners 44. Thepilot holes in vertebra V5 are disposed to connect spinal rods 234, 124in a selected alignment with bone fasteners 44 attached to vertebra V4and/or vertebra V6 along vertebrae V. Bone fasteners 44 connect anintermediate portion of spinal rods 234, 124 and plate 308 with vertebraV5. Plate 308 is removably engaged with a delivery instrument (notshown) and delivered along the surgical pathway. Plate 308 is deliveredto a surgical site adjacent vertebra V5. Plate 308 is oriented forfixation with vertebra V5. Bone fasteners 44 are inserted or otherwiseengaged with vertebra V5 to fix an intermediate portion of spinal rods234, 124 with plate 308 and vertebra V5.

Pilot holes are made in vertebra V6 for receiving bone fasteners 44being spaced laterally apart from each other along vertebrae V6. Thepilot holes in vertebra V6 are disposed to connect spinal rods 234, 124in a selected alignment with bone fasteners 44 attached to vertebra V5along vertebrae V. Bone fasteners 44 connect end 238 of spinal rod 234,end 128 of spinal rod 124 and plate 314 with vertebra V6. End 230 oftether 228 is threadably engaged with end 238 of rod 234. Plate 314 isremovably engaged with a delivery instrument (not shown) and deliveredalong the surgical pathway. Plate 314 is delivered to a surgical siteadjacent vertebra V6. Plate 314 is oriented for fixation with vertebraV6. Bone fasteners 44 are inserted or otherwise engaged with vertebra V6to fix ends 238, 128 with plate 314 and vertebra V6.

A pilot hole is made in vertebra V7 for receiving bone fastener 68. Thepilot hole in vertebra V7 is disposed to connect tether 228 in an axialalignment with rod 234. Bone fastener 68 connects an intermediateportion of tether 228 and plate 92 with vertebra V7. Plate 92 isremovably engaged with a delivery instrument (not shown) and deliveredalong the surgical pathway. Plate 92 is delivered to a surgical siteadjacent vertebra V7. Plate 92 is oriented for fixation with vertebraV7. Bone fastener 68 is inserted or otherwise engaged with vertebra V7to fix an intermediate portion of tether 228 with plate 92 and vertebraV7. Bone fasteners 68 are similarly inserted or otherwise engaged withvertebrae V8, V9 to fix tether 228 with plates 92 and vertebrae V8, V9.

As shown in FIG. 13, spinal rods 234, 124 are attached in a side by sideorientation with an apical portion of vertebrae V and disposed in asubstantially parallel arrangement adjacent a lumbar region of vertebraeV, and tether 222 and tether 228 are disposed in a substantiallyco-axial arrangement with rod 234 along vertebrae V.

It will be understood that various modifications may be made to theembodiments disclosed herein. Therefore, the above description shouldnot be construed as limiting, but merely as exemplification of thevarious embodiments. Those skilled in the art will envision othermodifications within the scope and spirit of the claims appended hereto.

What is claimed is:
 1. A spinal correction construct comprising: a firstmember configured for attachment to a first portion of vertebral tissue;a second member configured for attachment to a second portion of thevertebral tissue spaced from the first portion; a third member having anon-flexible configuration relative to the first and second members andbeing configured for attachment to an apical portion of the vertebraltissue and along at least a portion of at least two vertebra, the thirdmember extending between a first end connected to the first member at afirst transition configured for attachment to the first vertebral tissueand a second end connected to the second member at a second transitionconfigured for attachment to the second vertebral tissue.
 2. A spinalcorrection construct as recited in claim 1, wherein the first and secondmembers each include a tether and the third member includes a spinalrod.
 3. A spinal correction construct as recited in claim 1, whereineach of the members includes an elongated longitudinal element.
 4. Aspinal correction construct as recited in claim 1, wherein at least oneof the transitions include a plate.
 5. A spinal correction construct asrecited in claim 1, wherein the first transition includes a plateattached to a first vertebral level and the second transition includes aplate attached to a second vertebral level.
 6. A spinal correctionconstruct as recited in claim 1, wherein the first member and the secondmember are disposed in a substantially coaxial arrangement to define afirst longitudinal axis and the third member defines a secondlongitudinal axis spaced apart and disposed in a substantially parallelorientation relative to the first longitudinal axis.
 7. A spinalcorrection construct as recited in claim 1, wherein the members aredisposed in a substantially staggered orientation.
 8. A spinalcorrection construct as recited in claim 1, wherein the first and secondmembers define a first longitudinal axis and the third member defines asecond longitudinal axis, the first longitudinal axis being offset fromthe second longitudinal axis.
 9. A spinal correction construct asrecited in claim 1, wherein the members are disposed in a coaxialorientation.
 10. A spinal correction construct as recited in claim 1,wherein the third member includes a pair of spaced apart spinal rods.11. A spinal correction construct as recited in claim 1, wherein thefirst transition includes a plate having a first bone fastener fixedwith a vertebra and a second bone fastener fixed with the vertebra, thefirst bone fastener connecting the first member with the plate and thesecond bone fastener connecting the third member with the plate.
 12. Aspinal correction construct as recited in claim 1, wherein the thirdmember includes two spaced apart spinal rods and the first transitionincludes a plate integrally connected with the first and second members,the plate including a bone fastener fixed with a vertebra and connectingthe spinal rods with the plate.
 13. A spinal correction construct asrecited in claim 1, wherein at least one of the first member and thesecond member is concentric with the third member.
 14. A spinalcorrection construct as recited in claim 1, wherein the first transitionincludes an outer threaded surface of the first member and an innerthreaded surface of the third member, the threaded surfaces beingengageable to define the first transition.
 15. A spinal correctionsystem comprising: a first longitudinal element configured forattachment to a first portion of vertebral tissue; a second longitudinalelement configured for attachment to a second portion of the vertebraltissue spaced from the first portion; at least one intermediate elementhaving a non-flexible configuration relative to the first and secondlongitudinal elements and being configured for attachment to an apicalportion of the vertebral tissue and along at least a portion of at leasta first vertebra and a second vertebra; a first plate including a firstbone fastener fixed with the first vertebra and a second bone fastenerfixed with the first vertebra, the first bone fastener connecting thefirst longitudinal element with the first plate and the second bonefastener connecting a first end of the at least one intermediate elementwith the first plate; a second plate including a first bone fastenerfixed with the second vertebra and a second bone fastener fixed with thesecond vertebra, the first bone fastener connecting the secondlongitudinal element with the second plate and the second bone fastenerconnecting a second end of the at least one intermediate element withthe second plate.
 16. A spinal correction system as recited in claim 15,wherein the first longitudinal element and the second longitudinalelement are disposed in a substantially coaxial arrangement to define afirst longitudinal axis and the intermediate element defines a secondlongitudinal axis spaced apart and disposed in a substantially parallelorientation relative to the first longitudinal axis.
 17. A spinalcorrection system as recited in claim 15, wherein the elements aredisposed in a substantially staggered orientation.
 18. A spinalcorrection system as recited in claim 15, wherein the first and secondlongitudinal elements define a first longitudinal axis and theintermediate element defines a second longitudinal axis, the firstlongitudinal axis being offset from the second longitudinal axis.
 19. Aspinal correction system as recited in claim 15, wherein the elementsare disposed in a coaxial orientation.
 20. A spinal correction systemcomprising: a first tether configured for attachment to a first portionof vertebral tissue; a second tether configured for attachment to asecond portion of the vertebral tissue spaced from the first portion; atleast one spinal rod having a non-flexible configuration relative to thefirst and second tethers and being configured for attachment to anapical portion of the vertebral tissue and along at least a portion ofat least a first vertebra and a second vertebra; a first plate includinga first bone fastener fixed with the first vertebra and a second bonefastener fixed with the first vertebra, the first bone fastenerconnecting the first tether with the first plate and the second bonefastener connecting a first end of the at least one spinal rod with thefirst plate; a second plate including a first bone fastener fixed withthe second vertebra and a second bone fastener fixed with the secondvertebra, the first bone fastener connecting the second tether with thesecond plate and the second bone fastener connecting a second end of theat least one spinal rod with the second plate.